Sr Data Scientist, Clinical Intelligence

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Job Description

The Sr Data Scientist, Clinical Intelligence supports Medical Affairs by translating Caremark and Retail Pharmacy claims, dispensing, adjudication, and related data into clinically meaningful measures and actionable analyses. The role helps evaluate medication access, affordability, adherence, persistence, utilization, formulary performance, safety, and outcomes.

This individual contributor will contribute to recurring dashboards and key performance indicators as well as focused therapy-class, program, and product analyses. The role works under the direction of the VP, Data Strategy & Clinical Intelligence and partners with Caremark, Retail, Clinical Evidence Development, product, clinical, finance, technology, and analytics stakeholders.

Primary Job Duties & Responsibilities

· Applies SQL, statistical programming, and visualization tools to explore, analyze, and interpret large pharmacy datasets and solve defined clinical and business problems.

· Develops and maintains analytical frameworks, key metrics, and dashboard content related to medication access, affordability, adherence, utilization, formulary performance, quality, clinical outcomes, and operational performance.

· Translates stakeholder questions into documented analytic specifications, including eligible populations, treatment definitions, drug-code lists, index dates, baseline and follow-up periods, outcomes, and exclusions.

· Works with PBM and related client, member, drug, pharmacy, prescriber, prior-authorization, and payment data.

· Uses NDC, GPI, generic product, brand, therapeutic class, route, and other drug reference information to create and validate medication cohorts.

· Analyzes formulary compliance, preferred product use, generic and biosimilar adoption, exceptions, prior authorization, approval and overturn patterns, member out-of-pocket cost, specialty utilization, and other access or affordability measures.

· Partners with Clinical Evidence Development on feasibility assessments, exposure definitions, comparator selection, adherence measures, outcomes, confounding assessment, validation, and interpretation.

· Collaborates with the Sr. BI Engineer to operationalize validated measures and analytic datasets in governed, automated reporting products.

· Follows privacy, client-data segregation, security, access, and data governance requirements for protected health information and confidential business data.

Minimum Requirements

· 2 to 4 years of relevant experience in pharmacy analytics, PBM analytics, healthcare data science, pharmacoepidemiology, outcomes research, clinical informatics, or a related field.

· Experience working with pharmacy claims, dispensing data, medication utilization, or adherence measures.

· Proficiency in SQL and working proficiency in R, Python, SAS, or another statistical programming language.

· Working knowledge of drug identifiers and classifications such as NDC, GPI, generic product, brand, and therapeutic class.

· Experience developing dashboards, KPI frameworks, analytic datasets, or decision-support analyses.

· Working knowledge of problem solving and decision making, with strong attention to data detail and analytic accuracy.

· Ability to communicate technical and clinical findings to nontechnical stakeholders.

Preferred Qualifications

· Experience PBM data

· Knowledge of claims adjudication, prior authorization, formulary operations, specialty pharmacy, retail pharmacy, rebates, or net-cost concepts.

· Experience implementing PDC, persistence, PQA, CMS Star medication, formulary, biosimilar, or member-affordability measures.

· Experience with Google Cloud Platform, Tableau, Power BI, or Strategy.

Education

Bachelor's degree or equivalent specialized training or relevant professional qualification preferred. Advanced training in biostatistics, epidemiology, pharmacoepidemiology, health services research, public health, pharmacy, data science, informatics, statistics, or a related field is desirable.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$83,430.00 - $203,940.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

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